Single nucleotide polymorphisms of the genes encoding IL-10 and TGF-ß1 in Iranian children with atopic dermatitis.

BACKGROUND: Atopic dermatitis is an inflammatory skin disease in which both genetic and environmental factors interact to determine the susceptibility and severity of the disease. OBJECTIVE: The aim of this study was to determine the association between atopic dermatitis and IL-10 and TGF-ß1 gene polymorphisms. METHODS: The allele and genotype frequencies of genes encoding for IL-10 and TGF-ß1 were investigated in 89 patients with atopic dermatitis in comparison with 138 in the control group using the PCR-SSP method. RESULTS: A significant increase was found in the frequency of the TGF-ß1 codon 10/C allele among patients (p<0.001, OR=6.77), whereas a significant decrease was observed in the frequency of the T allele at the same position (p<0.001, OR=0.14). The frequency of the TGF-ß1 codon 25/G allele in the control group was significantly higher than among patients (p<0.001, OR=0.08). A significant positive correlation was seen between CC (p<0.001, OR=15.10) and CG (p<0.001) genotypes and AD at codons 10 and 25, respectively. The most frequent haplotypes among patients was TGF-ß1 CG which was significantly higher than in the control subjects (50% in patients vs. 39.9% in controls, p=0.042). A significant increase was found in the frequency of TGF-ß CC (36% in patients vs. 7.6% in controls, p<0.001) and TC (14% in patients vs. 0% in controls, p<0.001) haplotypes among patients compared to controls. By contrast, the TGF-ß1 TG haplotype was significantly lower in patients than controls (0% in patients vs. 52.5% in controls, p<0.001). There were no significant differences in the frequency of alleles, genotypes and haplotypes of the IL-10 gene. CONCLUSIONS: We found a strong association between the polymorphisms of the TGF-ß1 gene at codon 10 and codon 25 positions and atopic dermatitis.

Clinical, Laboratory, and Molecular Findings for 63 Patients With Severe Combined Immunodeficiency: A Decade´s Experience.

BACKGROUND: Severe combined immunodeficiency (SCID) is a life-threatening pediatric disease. We report on the clinical evaluation, immunological assessment, molecular analysis, and outcomes of SCID patients in a tertiary referral center in Iran. METHODS: From January 2006 to December 2015, we performed a prospective cohort study in which initial screening and advanced immunological tests were carried out on patients suspected of having SCID. Genetic analysis was also performed to confirm the diagnosis. RESULTS: A total of 63 patients were diagnosed with SCID (43 male [68.3%]). The median age at onset and diagnosis and diagnostic delay were 40 and 110 and 60 days respectively. A total of 49 patients (77.8%) had a history of BCG vaccination, and of these, one-third experienced BCG-associated complications. The most common clinical manifestations were pneumonia, recurrent oral candidiasis, chronic diarrhea, and failure to thrive. Of the thirteen patients who underwent hematopoietic stem cell transplantation, 8 survived and 5 died before they could receive the transplant. Most patients (34.9%) were classified as having T-B-NK+ SCID and had a mutation in the RAG2 or RAG1 gene. CONCLUSIONS: Autosomal recessive SCID is the most common type in Iranian patients. Providing high-quality training to physicians and patients' families to reduce the diagnostic delay should be prioritized. It is also important to raise awareness of live vaccination and to expand stem cell donor registries to speed up the transplantation process.

Single nucleotide polymorphisms of IL-2, but not IL-12 and IFN-γ, are associated with increased susceptibility to chronic spontaneous urticaria.

BACKGROUND: A clear picture of interaction of Th1/Th2 cytokines in pathogenesis of chronic spontaneous urticaria (CSU), remains elusive. Impaired IFN-γ production and decreased levels of IL-2 have been reported. The aim of this study was to evaluate the association of Th1 cytokines; IL-2, IL-12 and IFN-γ polymorphisms with CSU. METHODS: 90 patients with CSU and 140 age-sex matched subjects were included in this study. DNA samples were evaluated through PCR-SSP assay in order to detect single nucleotide polymorphisms of IL-12 (A/C -1188) or (rs3212227), IFN-γ (A/T UTR5644) or (rs2069717) and IL-2 (G/T -330 and G/T +166) or (rs2069762 and rs2069763). RESULTS: G allele at -330 at promoter region of IL-2 gene was overrepresented in CSU. Heterozygotes (GT) at this locus and heterozygotes at +166 of IL-2 gene (GT) were more prevalent in CSU group. Additionally, the haplotype GT for loci -330 and +166 of IL-2 gene was powerfully associated with CSU (OR (95%CI)=57.29 (8.43-112.7)). CONCLUSIONS: SNP at position -330 and +166 of IL-2 gene are differently expressed in CSU. The haplotype GT of IL-2 at -330 and +166 might confer vulnerability to a number of immunological disorders in Iranian region.

Primary Antibody Deficiency in a Tertiary Referral Hospital: A 30-Year Experiment.

BACKGROUND: Primary antibody deficiency (PAD) is the most common group of primary immunodeficiency disorders (PID), with a broad spectrum of clinical features ranging from severe and recurrent infections to asymptomatic disease. OBJECTIVES: The current study was performed to evaluate and compare demographic and clinical data in the most common types of PAD. MATERIALS AND METHODS: We performed a retrospective review of the medical records of all PAD patients with a confirmed diagnosis of common variable immunodeficiency (CVID), hyper IgM syndrome (HIgM), selective IgA deficiency (SIgAD), and X-linked agammaglobulinemia (XLA) who were diagnosed during the last 30 years at the Children's Medical Center, Tehran, Iran. RESULTS: A total number of 280 cases of PAD (125 CVID, 32 HIgM, 63 SIgAD, and 60 XLA) were enrolled in the study. The median (range) age at the onset of disease in CVID, HIgM, SIgAD, and XLA was 2 (0-46), 0.91 (0-9), 1 (0-26), and 1 (0-10) years, respectively. Gastrointestinal infections were more prevalent in CVID patients, as were central nervous system infections in XLA patients. Autoimmune complications were more prevalent in HIgM patients, malignancies in CVID patients, and allergies in SIgAD patients. The mortality rate for CVID, HIgM, and XLA was 27.2%, 28.1%, and 25%, respectively. No deaths were reported in SIgAD patients. CONCLUSIONS: SIgAD patients had the best prognosis. While all PAD patients should be monitored for infectious complications, special attention should be paid to the finding of malignancy and autoimmune disorders in CVID and HIgM patients, respectively.

Interleukin-6 and tumor necrosis factor-alpha gene polymorphisms in chronic idiopathic urticaria.

BACKGROUND: This study was performed to evaluate association of gene polymorphisms among proinflammatory cytokines and susceptibility to chronic idiopathic urticaria (CIU). METHODS: Ninety patients with prolonged urticaria more than 6 weeks were included as case group. Single nucleotide polymorphisms (SNPs) of IL-6 (G/C -174, G/A nt565) and TNF-α (G/A -308, G/A -238) were evaluated, using polymerase chain reaction (PCR); and the results were compared to the control group. RESULTS: G allele was significantly higher in the patients at locus of -238 of promoter of TNF-α gene (p<0.001). Frequency of following genotypes were significantly lower in patients with CIU, compared to controls: AG at -308 and GA at -238 of TNF-α gene (p<0.05 and p<0.001, respectively), CG at -174 and GG at +565 of IL-6 gene (p<0.05). Additionally, following genotypes were more common among patients with CIU: GG at -308 and -238 of TNF-α gene (p<0.05 and p<0.001, respectively), GG at -174 and GA at +565 of IL-6 gene (p<0.05). CONCLUSIONS: Pro-inflammatory cytokine gene polymorphisms can affect susceptibility to CIU. TNF-α promoter polymorphisms as well as IL-6 gene polymorphisms are associated with CIU.

Association of single nucleotide polymorphisms of interleukin-1 family with atopic dermatitis.

BACKGROUND: Interleukin-1 (IL-1) seems to have an important role in early reactions towards microbes, while its genetic variability could affect this role in atopic patients who have a distressed immunity towards dermatological infections. METHODS: Eighty-nine patients with atopic dermatitis (AD), who were referred to a main referral paediatric hospital, were enrolled in this study. Single nucleotide polymorphisms (SNP) of the following IL-1 cluster genes were assessed in this group of patients: IL-1α -889, IL-1ß -511, IL-1ß +3962, IL-1R Pst-I 1970, and IL-1RA Mspa-I 11100. The results were compared with a group of 140 healthy subjects from the same region. RESULTS: Fourteen percent of the controls had TT homozygous genotype in IL-1R at position Pst-I 1970, while only 2% of the patients with AD had this genotype (p=0.005, OR: 0.14, 95%CI: 0.02-0.64). The CC homozygous genotype was the most common genotype in IL-1α position -889 and IL-1ß at position +3962 in both groups of patients with AD and the controls, while the TC heterozygous genotype was the most common genotype in IL-1ß at position -511 and IL-1R at position Pst-I 1970, with no significant difference between the two groups. CONCLUSIONS: This study showed a significant negative association in the IL-1R Mspa-I 11100 TT homozygous genotype in the patients with AD.

Autoimmune phenotype in patients with common variable immunodeficiency.

BACKGROUND AND OBJECTIVE: Autoimmune disorders occur with a higher incidence in common variable immunodeficiency (CVID) patients than in the general population. To describe the clinical features of the autoimmune phenotype in patients with CVID. METHODS: The hospital records of all diagnosed CVID patients referred to the Children's Medical Center Hospital in Tehran, Iran between 2000 and 2010 were reviewed. Patients were also classified according to the presence or absence of autoimmune disease. RESULTS: Of 52 patients studied, 26.9% (n=14) had shown at least 1 autoimmune manifestation during the study period. Autoimmune cytopenias and juvenile rheumatoid arthritis were the most common form of autoimmunity in our series. Autoimmunity was significantly associated with polyclonal lymphocytic infiltrative disorders (P = .017), increased serum Immunoglobulin (Ig) M levels (P < .001), decreased IgE values (P = .04) and diminished switched memory B-cell count (P < .001). CONCLUSIONS: Because autoimmunity is one of the first manifestations in CVID, humoral immune system tests should be considered in autoimmune patients with a history of recurrent infection. The presence of polyclonal lymphocytic infiltrative disorders and decreased switched memory B-cells may predispose CVID patients to autoimmunity.

Association between the interleukin 6 genotype at position -174 and atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a chronic skin disorder of unknown origin that usually manifests for the first time in early infancy. Different types of genetic predisposition and environmental factors seem to be associated with the disease. METHODS: This study was performed to evaluate the frequency of alleles, genotypes, and haplotypes of interleukin (IL) 6 single-nucleotide polymorphisms (SNPs) at positions -174 and nt565 in 89 Iranian children with AD and 139 healthy controls. RESULTS: The G allele was significantly more frequent at position -174 in IL6 in atopic patients than in the healthy controls (P < .001; OR, 2.82). Genotype GG was found at the same position in 71% of the patients; this frequency was significantly higher than the frequency of 30% recorded in the controls (P < .001; OR, 5.60). The GG haplotype of IL6 (-174, nt565) was significantly more frequent in the atopic patients than in the healthy controls (P < .001; OR, 2.99). CONCLUSIONS: A significant increase in the frequency of the G allele and GG genotype at position -174 of IL6 was found in patients with AD, thus suggesting that production of this cytokine is greater in atopic patients.

Hexamita infection associated with diarrhoea and stunting in native turkey poults.

Hexamita sp. was identified in 8 cases of sixty (13.3%) stunted diarrhoeic 1- 12- week old native turkey poults. Large numbers of the flagellated parasites were found within the dilated crypts of Lieberkuhn of ileum and jejunum. In TEM studies on the parasagittal section of the parasite, elongated flagellated binuclear parasite was found. The morphological characteristics of the seen protozoan are similar with those described for Hexamita meleagridis. The parasite could be considered as an intestinal pathogenic protozoan parasite, causing stunting and diarrhoea in turkeys in Iran.

Asthma in patients with atopic dermatitis.

OBJECTIVE: This cross-sectional study was designed to estimate the frequency of asthma in patients with atopic dermatitis (AD), and its related factors. METHODS: The study population consisted of 236 patients with AD who were referred to Children Medical Center in 1997-2002 and their diagnosis was based on Hanifin & Rajka criteria. Severity of AD was categorized based on Severity Scoring of Atopic Dermatitis (SCORAD) index. Asthma was diagnosed with medical history and clinical examination (three or more episodes of wheezing and/or dyspnea and/or cough after 1 year old). The patients were divided in two groups according to having or not having asthma. RESULTS: The mean age of patients with AD was 38.67+/-2.68 month and the mean age at onset of asthma was 20+/-2.5 month. The frequency of asthma in AD patients was 27.5%. The mean of SCORAD in nonasthmatic patients was 52.27 +/- 2.52 and in asthmatic patients was 56.2+/- 4.2 (P= 0.4). The mean of duration of breastfeeding in asthmatic patients was 12.2+/-1.6 month and in non-asthmatic patients was 11.16+/-6.3 month (P = 0.87). There was no significant difference between asthmatic patients and others in serum IgE levels (P = 0.65) and blood eosinophil count. (P = 0.49). CONCLUSION: These results confirmed that development of asthma in patients with AD is more than normal population and AD can be a significant predisposing factor to developing asthma but the causative factors are not clear.

Effect of Ramadan on neutrophil's respiratory burst (innate immunity) and circulating immune complex.

BACKGROUND: The aim of this study was to investigate the effects of Ramadan fasting on neutrophil's respiratory burst and circulating immune complex (CIC) level. METHODS: The effects of Ramadan fasting on neutrophil's respiratory burst and CIC was studied in 21 normal young fasting Muslim individuals using standardized chemiluminescence and poly ethylene glycol methods respectively, the results obtained and statistically analysed. RESULTS: It was shown that in 11 cases out of 21 (52%) both of the chemiluminescence (CL) activity and CIC levels measured before and after Ramadan fasting were in normal range in spite of a insignificant decrease or increase in CL activity or CIC level. Therefore, the changes of the immunological parameters were not significant and the levels remained in the range of normal. In four cases out of 21 (24%), the CL activity and CIC levels were higher than normal range measured just before Ramadan, however after month of Ramadan the CL activity and CIC level decreased reaching to the normal level of these parameters. In four cases out of 21 (24%) there were an increase in CL activity and CIC levels after Ramadan fasting. CONCLUSION: There were no significant changes of CL activity of circulating neutrophils and CIC levels comparing the results obtained before and after Ramadan. More over there was a good correlation between these two immunological parameters measured in the present study.

ENT manifestations in Iranian patients with primary antibody deficiencies.

OBJECTIVE: One hundred and nine patients with primary antibody deficiencies were selected in order to determine the frequency of ENT complications. METHOD: Demographic information and ENT medical histories were collected for each patient. Duration of study for each patient was divided into two periods of before diagnosis and after diagnosis and the initiation of treatment. RESULTS: Eighty-two of 109 patients (75.2 per cent) experienced ENT infections during the course of the disease (63: otitis media, 75: sinusitis and nine: mastoiditis). At the time of diagnosis, 52 (47.7 per cent) out of 109 patients presented with an ENT symptom. The frequencies of episodes were 27 for sinusitis and 25 for otitis media (one complicated with mastoiditis). After immunoglobulin replacement therapy the incidence of otitis media was reduced from 1.75 before treatment to 0.39 after treatment per patient per year (p = 0.008). The incidence of sinusitis also significantly decreased from 2.38 to 0.78 (p value = 0.011). CONCLUSION: ENT infections are common medical problems in primary antibody deficiency patients. Persistent and recurrent ENT infections should be suspected as originating from a possible underlying immunodeficiency.

Intestinal cryptosporidiosis in turkeys in Iran.

Naturally occurring cryptosporidiosis is reported in turkey poults suffering from diarrhoea and unthriftness in Iran. Histological and ultrastructural studies revealed high number of Cryptosporidium developmental stages mainly located in the mid and terminal portions of small intestine of the poults. Other portions of the intestinal tract were less frequently infected. Oocyst shedding was detected only in 29% of the histologically positive birds. Based on host species, clinical signs, pathology and tissue location of the parasites, Cryptosporidium meleagridis was most likely responsible for these infections. This parasite was also reported recently in a child with diarrhoea in Iran.

Pulmonary complications in primary hypogammaglobulinemia: a survey by high resolution CT scan.

BACKGROUND: Primary hypogammaglobulinemia disorders are a group of heterogeneous immunodeficiency syndromes with an increased susceptibility to pulmonary complications. METHODS: The aim of this study was to evaluate the extent of lung abnormalities in primary hypogammaglobulinaemic patients by high resolution computed tomography (HRCT) scan and pulmonary function test (PFT). HRCT and PFT were performed in 22 Iranian patients with primary hypogammaglobulinemia. RESULTS: Pathological bronchial findings were observed in thirteen patients: three patients showed only peribronchial thickening and the remaining ten patients suffered from both bronchiectasis and peribronchial wall thickening. Mild type of bronchiectasis and peribronchial wall thickening were the most common type, predominantly observed in the right middle and both right and left lower lobe segments of lungs. Although bullae were not found, emphysema, air-trapping, and collapse/consolidation were observed in two patients. Bronchial involvement was mostly limited to 1 up to 5 bronchopulmonary segments; only one HRCT indicated bronchial involvement in more than nine bronchopulmonary segments. Pathological bronchial findings mostly observed in the proximal bronchi; meanwhile the involvement of the distal bronchi was less common. Decreasing FEVI and FVC were observed in 65% and 55% of patients, respectively. There was a significant correlation between the HRCT score and the predicted values by PFT. The delay of diagnosis in patients with bronchiectasis was significantly higher than those without bronchiectasis. CONCLUSIONS: It seems that the majority of hypogammaglobulinaemic patients suffer from the mild type of bronchiectasis, which is mostly observed in the proximal bronchi of the lower lobe segments. The delay of diagnosis plays an important role in the occurrence of this complication in these patients.

Tetrameres (Tetrameres) grusi (Shumakovich, 1946) (Nematoda: Tetrameridae) in Eurasian cranes (Grus grus) in central Iran.

The proventriculi of 11 Eurasian cranes (Grus grus) from central Iran were examined for the existence of parasitic helminths. Preliminary reports suggested that the death of these birds was related to untimely cold weather. Nine proventriculi (82%) were heavily infected by the nematode Tetrameres grusi. Glandular structure of the infected proventriculi was replaced by epithelial atrophy but significant inflammatory reactions were not observed in any of the infected organs. In serious infections, the nematode produced vast structural and functional changes, causing organ dysfunction and glandular necrosis. The coincidence of heavy helminth infection at times of environmental stress may lead to debilitation, wasting, and perhaps mortality in migratory cranes.

Gender similarity in low agreement between written and video ISAAC asthma questionnaires.

BACKGROUND AND AIM: The prevalence of childhood asthma varies among different nations and appears to have increased in recent years. It has been difficult to determine this prevalence precisely and compare the communities due to the lack of a standardized method. The International Studies of Asthma and Allergies in Childhood (ISAAC) has developed a written and video questionnaire to measure asthma prevalence and overcome these difficulties. This study was carried out to determine the prevalence of childhood asthma in Kashan, the central area of Iran, and to assess the agreement between the ISAAC written and video questionnaires and its gender relationship. METHODS: Between December 2002 and June 2003, 2533 school children, aged 13-14 years, in Kashan secondary schools completed sequentially the ISAAC written and video questionnaires. The agreement between responses to the two questionnaires for reported "ever wheeze", "exercise wheeze", "night wheeze" and "night cough" was determined, using kappa coefficient and concordance. RESULTS: The prevalence of asthma symptoms were significantly lower in the responses to the video questionnaire compared with the written questionnaire. Kappa coefficient showed only poor to fair agreement (kappa = 0.13-0.24) between video and written questionnaires, although the concordance between them always exceeded 60%. CONCLUSIONS: This study showed that reported asthma symptoms based on video questionnaires were significantly lower than the written questionnaire, and that there is low agreement between the two questionnaires which requires further investigation to explain the findings. In addition, this investigation revealed no significant difference between the genders for this low agreement.

Distribution of primary immunodeficiency disorders diagnosed in the Children's Medical Center in Iran.

Primary immunodeficiency disorders include a variety of diseases that render patients more susceptible to infections. To determine the percentage of different primary immunodeficiency disorders diagnosed in the Children's Medical Center Hospital affiliated to Tehran University of Medical Sciences in Iran, we retrospectively reviewed the charts of the patients being referred to our hospital for immunologic evaluation of recurrent infections during a 20 year period. Among these patients, antibody deficiencies were the most frequent ones and were found in 52.6% of patients (n = 130). T-cell disorders, phagocytic disorders and complement deficiencies were found to be present in 24.69% (n = 61). 22.2% (n = 55) and 0.4% (n = 1) respectively. On the whole, common variable immunodeficiency was the most frequent disorder (n = 65), followed by ataxia telangiectasia (n = 39), X-linked agammaglobulinemia (n = 33), chronic granulomatous disease (n = 29) and selective IgA deficiency (n = 20). This study reveals that antibody deficiencies are the most common type of disorders as shown in other studies. A comparative study shows some differences between our results and other registries. This article also indicates that immunodeficiency disorders should be considered in patients with recurrent infections.

Respiratory manifestations of chronic granulomatous disease; a clinical survey of patients from Iranian primary immunodeficiency registry.

Chronic granulomatous disease represents a group of inherited disorders of phagocytic system wherein recurrent infections are seen at different sites especially in the respiratory system. To determine the clinical spectrum of respiratory manifestations in chronic granulomatous disease patients, in this retrospective study, we used data from Iranian Primary Immunodeticiency Registry. The diagnosis was based upon WHO criteria for chronic granulomatous disease. We reviewed the records of 38 patients (26 males, 12 females), related to 33 families, 73% of whom were consanguineous. The median age at the time of the study was 12yrs (3 months-22 years). The median onset age of symptoms was 4 months (l month-12 years), and that of diagnostic age was 5 years (l month-20 years), with a diagnostic delay of 4.15 years, on an average. Sixty three percent of our patients had respiratory involvement in the course of their illness, including pneumonia (18 pts, 75%), tuberculosis (llpts, 46%), aspergillosis (3 pts, 12.5%), pulmonary abscess (3 pts, 12.5%), and bronchiectasis (1 pt, 4%). Only 4 of our patients presented with respiratory problems as their first manitestation. Lymph nodes were the first common site and the lungs were the second sites of involvement in chronic granulomatous disease patients; however, it is noteworthy that only in a few of our patients, it was the first manifestation of the disease. Thus special attention should be paid to the pulmonary complications while managing this disease.